A Veteran Presenting With Fatigue and Weakness.

: A 65-year-old male veteran presented to the Veterans Affairs Boston Healthcare System (VABHS) emergency department with progressive fatigue, dyspnea on exertion, lightheadedness, and falls over the last month. New bilateral lower extremity numbness up to his knees developed in the week prior to admission and prompted him to seek care. Additional history included 2 episodes of transient loss of consciousness resulting in falls and a week of diarrhea, which had resolved.

Succinate receptor 1 signaling mutually depends on subcellular localization and cellular metabolism.

Succinate is a pivotal tricarboxylic acid cycle metabolite but also specifically activates the G- and G-coupled succinate receptor 1 (SUCNR1). Contradictory roles of succinate and succinate-SUCNR1 signaling include reports about its anti- or pro-inflammatory effects. The link between cellular metabolism and localization-dependent SUCNR1 signaling qualifies as a potential cause for the reported conflicts.

Structural and functional analysis of the Nipah virus polymerase complex.

Nipah virus (NiV) is a bat-borne, zoonotic RNA virus that is highly pathogenic in humans. The NiV polymerase, which mediates viral genome replication and mRNA transcription, is a promising drug target. We determined the cryoelectron microscopy (cryo-EM) structure of the NiV polymerase complex, comprising the large protein (L) and phosphoprotein (P), and performed structural, biophysical, and in-depth functional analyses of the NiV polymerase.

Maternal adverse childhood experiences and lifetime experiences of racial discrimination: Associations with current household hardships and intergenerational health.

Growing evidence shows parents' exposure to adverse childhood experiences (ACEs) and lifetime experiences of racial discrimination (EOD) negatively impacts not only their own health, but also their children's health. ACEs and EOD can be conceptualized as a reflection of shared underlying adversities and structural injustices that manifest in inequitable educational and employment opportunities and differential treatment by public policies and programs that impede parents' capacity to support their families. Therefore, a potentially important, but underexplored, mechanism of effects of parent ACEs and EOD on the next generation is through effects on household material hardships.

Mixed representations of choice direction and outcome by GABA/glutamate cotransmitting neurons in the entopeduncular nucleus.

The basal ganglia (BG) are an evolutionarily conserved and phylogenetically old set of sub-cortical nuclei that guide action selection, evaluation, and reinforcement. The entopeduncular nucleus (EP) is a major BG output nucleus that contains a population of GABA/glutamate cotransmitting neurons (EP) that specifically target the lateral habenula (LHb) and whose function in behavior remains mysterious. Here, we use a probabilistic switching task that requires an animal to maintain flexible relationships between action selection and evaluation to examine when and how GABA/glutamate cotransmitting neurons contribute to behavior.

Chronic traumatic encephalopathy: State-of-the-science update and narrative review.

Objective: The long-recognized association of brain injury with increased risk of dementia has undergone significant refinement and more detailed study in recent decades. Chronic traumatic encephalopathy (CTE) is a specific neurodegenerative tauopathy related to prior exposure to repetitive head impacts (RHI). We aim to contextualize CTE within a historical perspective and among emerging data which highlights the scientific and conceptual evolution of CTE-related research in parallel with the broader field of neurodegenerative disease and dementia.

Single- versus two-test criteria for cognitive impairment: associations with CSF and imaging markers in former American football players.

 Cognitive impairment is a core feature of traumatic encephalopathy syndrome (TES), the putative clinical syndrome of chronic traumatic encephalopathy-a neuropathological disease associated with repetitive head impacts (RHI). Careful operationalization of cognitive impairment is essential to improving the diagnostic specificity and accuracy of TES criteria. We compared single- versus two-test criteria for cognitive impairment in their associations with CSF and imaging biomarkers in male former American football players.

Mineralocorticoid Receptor Antagonists in Diabetic Kidney Disease: Clinical Evidence and Potential Adverse Events.

Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease (CKD) globally and is associated with an increased risk of developing cardiovascular disease (CVD). DKD management requires a multipronged approach to decrease the progression of CKD and CVD. Mineralocorticoid receptor antagonists (MRAs) added to renin-angiotensin-aldosterone system blockade and sodium-glucose cotransporter 2 inhibitor therapy reduce the incidence of cardiovascular outcomes and progression of CKD.

Exposome-Wide Association Study of Thyroid Function Using U.S. National Health and Nutrition Examination Survey Data.

Previous epidemiologic studies examining thyroid function and chemical exposures have typically focused on a single or a limited number of chemical classes, often neglecting the effects of chemical mixtures. This study addressed this gap by exploring the associations between exposure to hundreds of chemicals and thyroid function using an exposome-wide association study (ExWAS) approach and National Health and Nutrition Examination Survey (NHANES) data. We analyzed data from three NHANES cycles (2007-2008, 2009-2010, 2011-2012), which include measures of thyroid function (free and total triiodothyronine [T3], free and total thyroxine [T4], thyroid-stimulating hormone [TSH]) and chemical biomarker concentrations from 9,082 participants.

A network analysis of clinician-rated posttraumatic stress disorder and substance use disorder symptom clusters in a sample of veterans seeking outpatient treatment.

The presentation of comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) differs by substance type. The current study applied network analysis to explore the relationships between diagnostic symptom clusters by examining the strength and direction of unique associations between PTSD and SUD. Network analyses were estimated using a sample of 422 veterans diagnosed with co-occurring PTSD/SUD initiating psychotherapy for PTSD while receiving concurrent outpatient SUD treatment as part of a randomized clinical trial.

Primary Antibody Deficiencies: Curation Of Gene-Disease Relationships Using A ClinGen Validation Framework.

Background: The Clinical Genome Resource (ClinGen) is an international collaborative effort between scientists and clinicians, diagnostic and research laboratories as well as the patient community. Using a standardized framework, ClinGen has established guidelines to classify gene-disease relationships as Definitive, Strong, Moderate, and Limited based on available scientific and clinical evidence. When the genetic and functional evidence for a gene-disease relationship has conflicting interpretations or contradictory evidence, they can be Disputed or Refuted.

Burden and Risk Factors of Stroke in Vietnam from 1990 to 2021 - A Systematic Analysis from Global Burden Disease 2021.

Background: Stroke is a leading cause of death in Vietnam. However, a comprehensive analysis of stroke burden remains limited. This study aims to investigate the burden of stroke and various risk factors in Vietnam from 1990 to 2021.

Narrative review of pediatric thyroiditis: Diagnosis and management.

Objective: To the best of the authors' knowledge, no current literature reviews on pediatric thyroiditis exist. Our aim is to present relevant and updated information on pediatric thyroiditis subtypes and presentations.

Data Sources: A narrative review was performed using PubMed and Embase.

Quantitative Pupillometry Predicts Neurologic Deterioration in Patients with Large Middle Cerebral Artery Stroke.

Objective: This study assesses whether longitudinal quantitative pupillometry predicts neurological deterioration after large middle cerebral artery (MCA) stroke and determines how early changes are detectable.

Methods: This prospective, single-center observational cohort study included patients with large MCA stroke admitted to Boston Medical Center's intensive care unit (2019-2024). Associations between time-to-neurologic deterioration and quantitative pupillometry, including Neurological Pupil Index (NPi), were assessed using Cox proportional hazards models with time-dependent covariates adjusted for age, sex, and Alberta Stroke Program Early CT Score.

Implementation effectiveness of 'Problem solving for better health' training in Lesotho using mixed methods and the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework.

Background: Healthcare resources have been concentrated in urban areas, leaving rural regions vulnerable to poorer health outcomes. The Problem Solving for Better Health (PSBH) program was implemented to enhance healthcare systems in resource-limited regions by training personnel to maximize existing resources in problem-solving. This study evaluated the implementation effectiveness of PSBH-Nursing (PSBHN), a nationally led initiative to train nurses in PSBH in Lesotho.

Comprehensive Review of Multilingual Patient-Reported Outcome Measures for Dysphonia.

Introduction: Patient-reported outcome measures (PROMs) represent an important part of a comprehensive voice assessment for clinical care and research. Access to multilingual PROMs enables inclusion of information from diverse patient populations. This review compares available translated and validated PROMs for adult dysphonia.

Comparison of Imaging Findings between Granulomatosis with Polyangiitis and Eosinophilic Granulomatosis with Polyangiitis on Sinus CT: Importance of High-Density Opacification of the Paranasal Sinuses.

Background And Purpose: Granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (EGPA) are the most common causes of chronic sinusitis from systemic granulomatous diseases. While both are small- to medium-sized vasculitis with necrotizing granulomas, they have different clinical courses and prognoses. High-density sinus opacification has been reported in allergic fungal sinusitis with eosinophilic infiltrates.

Estimating the epidemiological and economic impact of providing nutritional care for tuberculosis-affected households across India: a modelling study.

Background: Approximately 20% of global tuberculosis incidence is attributable to undernutrition, increasing to more than a third in India. Targeting nutritional interventions to tuberculosis-affected households is a policy priority, but understanding of epidemiological and economic impacts is limited. We aimed to estimate the population-level epidemiological and economic effect of such an intervention.